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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015601410
Report Date: 06/28/2021
Date Signed: 06/28/2021 06:08:07 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME:ARCADIAN RESIDENTIAL COMMUNITYFACILITY NUMBER:
015601410
ADMINISTRATOR:LULIN WUFACILITY TYPE:
740
ADDRESS:24647 MOHR DRIVETELEPHONE:
(510) 887-8898
CITY:HAYWARDSTATE: CAZIP CODE:
94545
CAPACITY:38CENSUS: 38DATE:
06/28/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
04:00 PM
MET WITH:Lulin 'Lucy' Wu/AdministratorTIME COMPLETED:
06:15 PM
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Licensing Program Analyst (LPA) Delmundo arrived unannounced to conduct an annual required inspection. LPA met with Administrator Lulin 'Lucy' Wu and informed the purpose the visit. Wendy Wong and Olive Manalastas, licensees, arrived after about 45 minutes.

LPA toured the facility with Lulin Wu. LPA randomly selected 6 residents' rooms (room #'s 12, 8, 9, 5, C and B) for inspection. LPA also inspected the common areas, reception area, dining room, kitchen, shower room/bathroom, ensuite toilets. Medications are centrally stored in a locked area that is inaccessible to residents and refilled every 30 days. Per Lulin Wu, facility conducts inventory of medications every week. Perishable and non-perishable food supplies were observed sufficient. LPA observed a central screening station for COVID-19 with hand sanitizer and visitor's log by the entrance door. COVID-19 posters were observed posted all through out the facility. Personal protective equipments (PPEs) including but not limited to N95 respirators, surgical masks, disposable gowns, hand sanitizers, face shields were observed sufficient for 30 days.

Water temperature in the bathroom was tested and measured at 115 degrees Fahrenheit. Fire extinguishers checked, observed fully charge and tags showed serviced February 10, 2021. Facility has working smoke and carbon monoxide detectors.

LPA verified with the administrator and licensees who indicated fit testing for N95 respirators for all staff has not been conducted.

A copy of current LIC500 Personnel Report received on this day.

Exit interview conducted and copy of this report provided to Lulin Wu.
SUPERVISOR'S NAME: Bennett FongTELEPHONE: (510) 622-2621
LICENSING EVALUATOR NAME: Alicia DelmundoTELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:

DATE: 06/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
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